South Carolina Insurance Practice Exam

In which type of health plan are scheduled payments made based on specific injuries or surgical procedures?

1. Indemnity plan

2. Managed care plan

3. Benefit schedule plan

4. High-deductible plan

The correct answer is: Benefit schedule plan

The correct answer is the benefit schedule plan. This type of health plan is structured around predetermined payments for specific injuries or surgical procedures. Each procedure or event covered has a specific benefit amount associated with it, which means that policyholders are aware upfront of how much their plan will pay for various treatments or services. This can help individuals estimate their out-of-pocket costs and make more informed decisions regarding their healthcare. Benefit schedule plans often categorize procedures and assign specific monetary benefits for each, promoting transparency and predictability in healthcare expenses. This is essential for budgeting and understanding the financial implications of medical care when beneficiaries experience injuries or need surgeries. In contrast, indemnity plans provide broader coverage without specific scheduled payments for individual procedures, allowing more flexibility but potentially leading to higher out-of-pocket costs. Managed care plans emphasize coordinated care among providers and often incentivize members to use a network of doctors, which can limit the variety of services covered and their respective payouts. High-deductible plans shift more upfront costs to policyholders before coverage kicks in, which may not align with the scheduled payments characteristic of benefit schedule plans.